Τίτλος:
Changing Demographics, Temporal Trends in Waitlist, and Posttransplant
Outcomes After Heart Transplantation in the United States: Analysis of
the UNOS Database 1991-2019
Περίληψη:
Background: We sought to investigate temporal trends in patient
characteristics, waitlist, and posttransplant outcomes after heart
transplantation in the United States. Methods: Using data from the
United Network of Organ Sharing, we identified adults listed for heart
transplantation between 1991 and 2019. Patients were divided into 4 eras
based on the 3 time points in which changes were made to the patient
selection/allocation policy (Era 1=January 1991-January 1999; Era
2=January 1999-July 2006; Era 3=July 2006-October 2018; and Era
4=October 2018-March 2020), and patient characteristics, waitlist, and
posttransplant outcomes were evaluated for each era. Results: Between
1991 and 2019, 95 179 patients were added to the heart transplantation
waitlist. Compared with Era 1, patients listed in Era 4 were older (mean
age: 50 versus 52 years) and with higher risk comorbidities (eg, 10%
versus 28.8% diabetes, 23.3% versus 35.6% obese). Over the study
period, 22 738 patients died or were permanently delisted for
deterioration on the waitlist while 61 687 were transplanted. Compared
with the preceding era, there was significant decrease in death or
deterioration in the last 2 eras (sub-hazard ratio, 0.67 [95% CI,
0.65-0.70] for Era 3 versus Era 2 and sub-hazard ratio, 0.65 [95% CI,
0.58-0.73] for Era 4 versus 3). Across the years, 27.1% to 40.5% of
those on the waitlist were transplanted. Among those transplanted, there
was increase in the rates of in-hospital stroke (2.8% in Era 1 to 3.7%
in Era 4), renal failure requiring dialysis (7.2%-17.1%), and
length-of-stay (14-17days), P<0.001. However, this did not negatively
impact short-term survival when compared with the preceding era (1-year
graft survival from Era 1 to Era 4=84.1%, 86.4%, 90.4%, and 89.7%,
respectively). Conclusions: There have been significant changes in the
characteristics of patients listed for heart transplantation. Although
transplant volume has increased, the wide supply-demand gap persisted.
The last two changes in the allocation policy achieved their primary
objective of reducing waitlist mortality.
Συγγραφείς:
Akintoye, Emmanuel
Alvarez, Paulino
Shin, Doosup
Egbe,
Alexander
Panos, Anthony
Sellke, Frank
Briasoulis,
Alexandros
